Perspectives of emergency department physicians and nurses on reasons for preventable emergency department visits by patients with cancer.

BACKGROUND: Patients with cancer frequently visit the emergency department (ED) for medical care, yet approximately half of ED visits for patients with cancer are thought to be preventable. Preventable ED visits are associated with increased healthcare costs and poor patient experiences and outcomes. The voices of ED providers who work with patients with cancer in their everyday practices have not been solicited as it pertains to preventable visits. OBJECTIVES: The purpose of this study is to describe the perspectives of ED physicians and nurses on reasons for preventable ED visits by patients with cancer. METHODS: A qualitative descriptive design guided the study. We conducted 23 semi-structured interviews with ED physicians and nurses to query them about their perspectives on the reasons for preventable ED visits by patients with cancer. Content analysis was conducted to list and describe the reasons they discussed. RESULTS: Participants identified five "medical" and five "non-medical" causes of preventable ED visits. Medical reasons included uncontrolled cancer pain, gastrointestinal symptoms, anemia, fever, and on-going undiagnosed signs and symptoms. Non-medical reasons include patient hesitancy to contact primary care providers, lack of availability or responsiveness of primary providers, lack of access, lack of care coordination, and fears about diagnosis and treatment. CONCLUSION: The voices of ED providers should be included in discussions about the problem of preventable ED visits by patients with cancer. The reasons supplied by the participants suggest that solutions to the problem will need to occur at the patient, provider, system, and societal levels.

Implementation of Research in Community Mental Health Centers: The Challenge of Provider Engagement.

Conducting clinical research in public sector community mental health centers (CMHCs) can be challenging. The purpose of this report is to describe the challenges our research team encountered in engaging CMHC providers in a clinical trial aimed at testing an intervention to improve parent activation and engagement in their child's behavioral healthcare. We discuss the intervention we aimed to test, the challenges we encountered engaging providers, and the barriers to engagement that we identified. The barriers included restrictive inclusion criteria, an ambitious randomized controlled design, a dyadic (provider-parent) recruitment plan, a requirement to record provider-parent sessions, and high day-to-day practice demands on providers. The strategies we used to address the barriers and a discussion of the "trade-offs" these strategies introduced are presented. Improving provider engagement in research in CMHCs can avoid research delays or termination of studies and ultimately mitigate an early blockage in the research-to-practice pipeline.

Mentoring in Academic Nursing From the Perspectives of Faculty Mentors.

AIM: The aim of this study was to create a theoretical framework that describes how mentoring relationships in academic nursing unfold from the perspectives of nurse faculty mentors. BACKGROUND: Mentoring is a strategy that can promote the satisfaction and retention of nurse faculty. Although research has focused on the experiences of protégés in mentoring relationships, little is known about mentoring from the perspectives of nurse faculty mentors. METHOD: Constructivist grounded theory was used to interview 24 experienced nurse faculty about their mentoring experiences. RESULTS: The theoretical framework Growing Together: Mentors' Perspectives on Mentoring included four phases (getting together, getting going, going together, going beyond) and three strands (relationship with protégé, work of mentoring, emotional impact of mentoring). CONCLUSION: Participants experienced a variety of benefits from mentoring while also experiencing a variety of challenges. Findings suggest that more resources are needed for experienced faculty who mentor novice nurse faculty.

Overlooked Symptoms in Autoimmune Hepatitis Negatively Impact Many Facets of Life.

BACKGROUND: Significant reduction in quality of life among patients with autoimmune hepatitis (AIH) patients has been observed in several studies. While acute symptoms associated with AIH have been well described, little is known about the overall impact of living with AIH on patients' quality of life. The aim of this qualitative descriptive study was to describe the impact of AIH and associated symptoms on quality of life from the perspectives of patients living with AIH. METHODS: Patients from Autoimmune Hepatitis Association support groups were recruited to participate in one of five online focus groups conducted between August and September 2020. After enrollment, patients were asked to complete a brief demographic and disease history questionnaire. A single moderator conducted interviews with each group guided by seven questions focused on the impact of AIH on the participants' quality of life. Each session was recorded, transcribed, and verified. Content analysis was used to summarize the participants' responses. RESULTS: The participants' discussed three overarching topics: (a) symptoms of AIH and medication side effects, (b) the impact the disease and symptoms/side effects on five domains of quality of life (work life, relationships with friends and family, social life, leisure activities, and diet and exercise) and (c) interactions with healthcare providers and recommendations for future research. CONCLUSIONS: Living with AIH can have profound effects on patients' quality of life in several domains. Healthcare providers and the AIH research community should focus on developing further strategies that can improve the quality of life in persons suffering from AIH.

Exploring Mentoring Relationships Among Novice Nurse Faculty: A Grounded Theory.

AIM: The aim of this study was to develop a theoretical framework that describes the mentoring process from the perspectives of novice nurse faculty. BACKGROUND: Additional nurse faculty are needed to help combat the nurse faculty shortage, but many who enter the faculty role come from professional and educational backgrounds that may not equate to success with the tripartite faculty role. Mentoring is promoted as an intervention for career development. Little is known about the process of mentoring relationships and the transition among novice nurse faculty into academia. METHOD: Grounded theory was used to interview full-time novice nurse faculty (N = 21) with three years or less in the faculty role from US nursing programs. RESULTS: The theoretical framework Creating Mentorship Pathways to Navigate Academia captures the process of mentoring as experienced by novice nurse faculty. CONCLUSION: Participants created mentorship pathways to navigate academia by acquiring knowledge, meeting expectations, and functioning in the faculty role.

Reasons for and associated characteristics with early study termination: Analysis of ClinicalTrials.gov data on pregnancy topics.

BACKGROUND: Prematurely terminated studies are unlikely to provide data for evidence-based practice. There has been no systematic review on premature study termination on pregnancy-related research. PURPOSE: This study investigated the reasons why studies on pregnancy topics are terminated and the associated characteristics with early termination. METHODS: A total of 3,623 studies (332 terminated and 3,291 completed) were retrieved from ClinicalTrials.gov registry. Reasons for termination were grouped into four categories, including accrual difficulty, research operation issues, data-related recommendations, and external factors. Study characteristics were statistically compared between terminated and completed studies. FINDINGS: Accrual difficulty (44.6%) and research operation issues (21.4%) were most frequently cited reasons for termination. Study design characteristics of intervention, randomization, masking, treatment and drug trial, and low funding from federal agencies were significantly associated with early termination. DISCUSSION: Population tailored subject recruitment strategies, scientifically sound research protocols, and well-planned research operations may mitigate premature study termination.

A study of Indiana University Health's spirit of inquiry and innovation during COVID.

BACKGROUND: COVID-19 has required nursing innovations to meet patient care needs not previously encountered. PURPOSE: The purpose of this study was to describe nursing innovations conceived, implemented, and desired during the first COVID-19 surge. METHODS: The investigators invited registered nurses employed across 16 Midwest hospitals (6,207) to complete the survey. Respondents provided demographics and written descriptions of innovations they conceived, witnessed, and desired. Investigators analyzed text responses using standard content analytic procedures and summarized quantitative demographics using percentages. FINDINGS: Nurses reported seven types of innovations that would (a) improve personal protective equipment (PPE), (b) limit the need to repeatedly don and doff PPE, (c) ensure safer practice, (d) conserve and access supplies, (e) provide patient and family education and support, (f) make team member communication more efficient, and (g) improve peer support. DISCUSSION: Nurses are in a unique position to generate innovative solutions to meet patient care needs under adverse and rapidly changing situations.

Patient Activation of Persons With Opioid Use Disorder in Intensive Outpatient Treatment.

BACKGROUND: High patient activation is associated with a variety of positive health outcomes. Although increasing patient activation in persons with opioid use disorder (OUD) in intensive outpatient treatment (IOT) programs may increase engagement and improve outcomes, little is known about how patient activation is manifested in these programs. AIMS: To describe types of instances in which persons play an active role in their IOT or show self-determination in their recovery generally (patient activation) and types of instances in which they play a passive role in their IOT or have recovery directed by others (patient nonactivation). METHODS: A qualitative descriptive study using data from a larger grounded theory study was conducted. Interviews were completed with 14 persons with OUD who attended an IOT program within a large health care system in the Midwest. Content analysis was used to create a typology of instances of patient activation or nonactivation in participants' IOT experiences. RESULTS: Six types of instances were identified: (1) making and enacting one's own treatment decisions, (2) actively collaborating with staff, (3) self-determining one's disclosure in groups, (4) making a commitment to treatment, (5) taking responsibility for one's recovery, and (6) taking actions to avoid return to use. CONCLUSIONS: Patient activation is multidimensional and plays a salient role in IOT experiences. IOT staff should engage patients as active participants in their treatment and encourage mutual goal-setting and shared-decision but should be aware that some approaches used too early in treatment may impede recovery.

Implementation of screening, brief intervention, and referral to treatment (SBIRT) by nurses on acute care units: A qualitative descriptive study.

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention for patients with substance use disorders, but this intervention is under-utilized. Little is known about the implementation of SBIRT in acute care facilities. The purpose of this study is to describe implementation of SBIRT by nurses in acute care hospitals. Methods: A qualitative descriptive design was used for this study. Registered nurses who agreed to participate in the study completed a 1:1 interview using a semi-structured interview guide. Interviews were audio recorded and transcribed and then data were analyzed using qualitative content analysis. Results: When implementing SBIRT in an acute care setting, participants identified several factors that affect implementation. Some nurses felt that it is "one more thing to do" but other nurses feel that it was a "good, simple" screening tool that does not take long to do and can "plant the seeds of change" for patients. Additionally, participants mentioned barriers and facilitators related to the patients' responses to SBIRT and organizational factors. Conclusions: This study identified several barriers and facilitators to SBIRT implementation related to the nurses, patients, and organization. By understanding the factors that influence implementation, healthcare providers can develop strategies to support effective implementation of SBIRT.

The Influence of Peer Relationships on Latina Adolescents' Experiences with Depressive Symptoms.

PURPOSE: Previous research has demonstrated that peers may play an integral role in the development of depressive symptoms among Latina adolescents; however, little is known about the function of peers in the ongoing management of depressive symptoms for Latina adolescents. The purpose of this study was to describe how peers influence Latina adolescents' experiences with the onset and ongoing management of depressive symptoms. DESIGN AND METHODS: Qualitative descriptive methods were used in conducting semi-structured interviews with twenty-five young Latinas (ages 13-20) who had a history of depressive symptoms during adolescence. Participants were asked to describe their experiences with depressive symptoms and how they interacted with others in relation to their depressive symptoms. Thematic analysis methods were used to identify common themes in how peers influenced Latina adolescents' experiences with depressive symptoms. RESULTS: Latina adolescents experienced tensions with peers in the development, disclosure, and self-management of depressive symptoms. Peers were: 1) allies and bullies; 2) confidants and betrayers; and 3) up-lifters and downers. CONCLUSIONS: Peer relationships can be a source of risk and resiliency for Latina adolescents throughout the process of experiencing depressive symptoms. PRACTICE IMPLICATIONS: Interventions preventing or treating depression among Latina adolescents should capitalize on the strengths of peer relationships, while recognizing that peers may also contribute to risk.

Barriers to and Facilitators of Mental Health Treatment Engagement Among Latina Adolescents.

Latina adolescents are more likely to experience depressive symptoms and less likely to receive mental health treatment than White peers. The purpose of this study is to describe barriers to and facilitators of engagement in depression treatment among Latina adolescents. Twenty-five Latina young women (mean age = 16.7 years) with a history of depressive symptoms during adolescence participated in this qualitative descriptive study. Participants were recruited from clinical and community settings and were interviewed about their experiences with depression treatment. Using qualitative content analysis, we identified barriers to and facilitators of engagement in treatment for depression. Barriers included beliefs about depression and its treatments, negative experiences with treatment, and logistical problems. Facilitators included positive treatment outcomes, meaningful connection with a therapist, and family support of depression treatment. Mental health providers should minimize barriers and maximize facilitators to promote mental health treatment use and engagement among Latina adolescents with depressive symptoms.

Development and Feasibility of SymTrak, aMulti-domain Tool for Monitoring Symptoms of Older Adults in Primary Care.

BACKGROUND: A clinically practical, brief, user-friendly, multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE: Develop and assess usability, administration time, and internal reliability of SymTrak. DESIGN AND PARTICIPANTS: Phase I: legacy instruments, content validity, analyses of existing data, focus groups (physicians, nurses, patients, informal caregivers), and Think Aloud interviews (patients, caregivers) were used to develop SymTrak. Phase II (pilot feasibility study): 81 (27 patient-caregiver dyads, 27 patients without an identified caregiver) participants were self-administered SymTrak in clinic. MAIN MEASURES: SymTrak and demographic questions. KEY RESULTS: Consistent themes emerged from phase I focus groups. Ambiguous wording was corrected with Think Aloud feedback. In phase II, patients and caregivers preferred circling words instead of numbers for item response options. SymTrak self-administration completion time in clinic was brief; mean was 2.4, 3.0, and 3.3 min for the finalized circlingwords version, respectively, for caregivers, dyadic patients, and patients without a caregiver; and the maximum was 6.2 min for any participant. Usability questionnaire ratings were high. Cronbach's alpha for the SymTrak 23-item total score was 0.86, 0.79, and 0.81 for caregivers, dyadic patients, and patients without a caregiver, respectively. CONCLUSIONS: SymTrak demonstrates content validity, positive qualitative findings, high perceived usability, brief self-administered completion time, and good internal reliability.

Reliability and Validity of SymTrak, a Multi-Domain Tool for Monitoring Symptoms of Older Adults with Multiple Chronic Conditions.

BACKGROUND: A reliable and valid clinically practical multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE: Assess internal consistency reliability, test-retest reliability, construct validity, and sensitivity to change for SymTrak. DESIGN AND PARTICIPANTS: Among 600 (200 patient-caregiver dyads, 200 patients without an identified caregiver) participants, SymTrak was telephone interviewer-administered at baseline and 3-month follow-up, and at 24 h post-baseline for assessing test-retest reliability in a random subsample of 180 (60 dyads, 60 individual patients) participants. MAIN MEASURES: Demographic questions, SymTrak, Health Utility Index Mark 3 (HUI3). KEY RESULTS: Exploratory factor analysis indicated a single dominant dimension for SymTrak items for both patients and caregivers. Coefficient alpha and 24-h test-retest reliability, respectively, were high for the 23-item SymTrak total score for both patient-reported (0.85; 0.87) and caregiver-reported (0.86; 0.91) scores. Construct validity was supported by monotone decreasing relationships between the mean of SymTrak total scores across the poor-to-excellent categories of physical and emotional general health, and by high correlations with HUI3 overall utility score, even after adjusting for demographic covariates (standardized linear regression coefficient = - 0.84 for patients; - 0.70 for caregivers). Three-month change in the SymTrak total score was sensitive to detecting criterion standard 3-month reliable change categories (Improved, Stable, Declined) in HUI3-based health-related quality of life, especially for caregiver-reported scores. CONCLUSIONS: SymTrak demonstrates good internal consistency and test-retest reliability, construct validity, and sensitivity to change over a 3-month period, supporting its use for monitoring symptoms for older adults with MCCs.

Understanding the decision to screen for lung cancer or not: A qualitative analysis.

BACKGROUND: Although new screening programmes with low-dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening-eligible persons' decisions to screen or not remain poorly understood. OBJECTIVE: To describe how current and former long-term smokers explain their decisions regarding participation in lung cancer screening. DESIGN: Phone interviews using a semi-structured interview guide were conducted to ask screening-eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques. SETTING AND PARTICIPANTS: A subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements. RESULTS: The sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening-eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x-ray. A physician recommendation was a key influence on decisions to screen. DISCUSSION AND CONCLUSIONS: Education initiatives aimed at providers and long-term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates.

Using REDCap to Facilitate Web-Based Therapeutic Intervention Research.

BACKGROUND: Limited guidelines to assist nurse researchers who use web-based interventions are available. Nurses must develop the supporting technology enabling participants to complete study activities and collected data while maintaining data security and participant confidentiality. OBJECTIVES: The aim of the study was to describe how the authors used advanced Research Electronic Data Capture (REDCap) functionality to support the data management infrastructure of an interactive, web-based therapeutic intervention. METHODS: The data management infrastructure for the WISER (Writing to Improve Self-in-Relationships) intervention pilot study consisted of two components: a website for presentation of the intervention and participant account management and a REDCap project for data capture and storage. The REDCap application programming interface connected these two components using HTML links and data exchanges. RESULTS: We completed an initial pilot study of WISER with 14 participants using the REDCap-based infrastructure. Minimal technical difficulties were encountered. DISCUSSION: REDCap is cost-effective, is readily available, and, through its advanced functionality, is able to facilitate confidential, secure interactions with participants, robust data management, and seamless participant progression in web-based intervention research.

Getting a Grip on My Depression: How Latina Adolescents Experience, Self-Manage, and Seek Treatment for Depressive Symptoms.

Latina (female) adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than their non-Latina White peers. We aimed to develop a framework that explains how Latina adolescents experience, self-manage, and seek treatment for depressive symptoms. Latina young women (n = 25, M age = 16.8 years) who experienced depressive symptoms during adolescence were recruited from clinical and community settings and interviewed about experiences with depressive symptoms. The framework was developed using constructivist grounded theory methods. Participants experienced a psychosocial problem that we labeled being overburdened and becoming depressed. They responded to this problem through a five-phase psychosocial process that we labeled Getting a Grip on My Depression. Family members, peer groups, and mainstream authorities were influential in how participants experienced these phases. Future research should further develop this framework in diverse samples of Latino/a youth. Clinicians can use this framework in discussions with Latina adolescents about depressive symptoms.

Cultural stressors experienced by young Latinas with depressive symptoms living in a tumultuous sociopolitical climate in the United States.

The purpose of this study is to describe the cultural stressors experienced by Latina young women with depressive symptoms from 2016 to 2018 in the United States. Twenty-four Latina young women (mean age = 16.7 years) participated in this qualitative descriptive study. Content analysis of interviews revealed four cultural stressors: Parental oversight, pressure to succeed, being treated differently, and fears of deportation. Experiences with cultural stressors varied across generational status. Clinicians should provide Latina young women with a safe space for discussing cultural stressors, assess how they are managing their stress, and advocate for policies that will benefit the well-being of Latina young women.

A feasibility test of an online intervention to prevention dating violence in emerging adults.

Dating violence in emerging adults is a significant problem and few prevention programs based on the developmental needs of this age group have been developed. Our research team developed an online dating violence prevention program called WISER (Writing to Improve Self-in-Relationships) for emerging adults. The program is based on narrative therapy principles and uses structured writing techniques. A single group pre-post feasibility test of WISER was conducted with 14 college women. WISER was demonstrated to be feasible and acceptable and to show promise as an effective program to decrease dating violence in this population.

Emerging Adult Women's Views-of-Self in Intimate Partner Relationships That Are Troubled.

The purpose of this study is to describe how emerging adult (EA) women describe their views-of-self in troubled relationships. Fourteen EA women (ages 18-25 years) wrote four stories about their troubled relationships during a guided-writing intervention. Qualitative descriptive methods and content analysis were used to identify common views-of-self. Four views-of-self in troubled relationships and contrasting views-of-self emerged: (i) silent self-vocal self, (ii) sacrificing self-prioritized self, (iii) caretaking self-boundary-setting self, and (iv) insecure self-secure self. Mental health nurses and other clinicians can use these views-of-self pairs to guide their discussions with EA young women who are involved in troubled relationships.

Cultural Stressors and Depressive Symptoms in Latino/a Adolescents: An Integrative Review.

BACKGROUND: Latino/a adolescents experience higher levels of depressive symptoms than Caucasian and African American adolescents. Many studies found that cultural stressors contribute to this disparity, but these findings have not been integrated into a cohesive picture of the specific cultural stressors that contribute to the development of depressive symptoms for Latino/a adolescents. OBJECTIVE: The purpose of this integrative review is to identify cultural stressors that are associated with depressive symptoms in Latino/a adolescents. DESIGN: Procedures outlined by Ganong were used to conduct the review. The results of 33 articles that met inclusion criteria were synthesized. RESULTS: Discrimination, family culture conflict, acculturative and bicultural stress, intragroup rejection, immigration stress, and context of reception were identified as cultural stressors that are associated with depressive symptoms in Latino/a adolescents. CONCLUSIONS: Clinicians should employ strategies to help Latino/a youth cope with cultural stressors and advocate for policies that support the mental health of Latino/a youth.